The San Francisco Bay Area has become one of the most culturally diverse regions in the country, and the ethnic groups considered minorities throughout much of the nation will together soon constitute the majority. Many members of these groups are not well served by the existing medical care system, particularly with regard to preventive services. We propose the Breast and Cervical Cancer Intervention Study (BACCIS) as a catalyst to a comprehensive plan for cancer control research. BACCIS will study methods for establishing accessible, more affordable screening and ready access to treatment for under-served, multi-ethnic women through county- operated outpatient clinics. The team assembled for this research reflects the multi-disciplinary expertise of our consortium cancer center, the Northern California Cancer Center (NCCC), in close collaboration with an established community-based public health coalition devoted to cancer control, the Bay Area Cancer Coalition (BACC). This partnership supports ready access to the target populations and provides for rigorous evaluation of proposed interventions. We will apply these skills in a randomized controlled trial targeting an estimated 25,000 White, Black, Hispanic and Chinese low-income women, ages 40 to 75, who reside in San Francisco and Contra Costa counties. The BACCIS interventions will adapt tested methods to the needs of distinct cultures and the demands of county-operated outpatient clinics and hospitals. We will test the following intervention components separately and in combination: community outreach in which indigenous outreach workers bring women to Women's Health Days that offer low-cost mammography, Pap smears, clinical breast examination, and instruction in self-breast examination and nutrition; clinic inreach which include education of providers on minimal intervention, culturally tailored screening messages to patients, peer comparison feedback for providers, and a computerized reminder system; and treatment coordination which includes case management of abnormal screening reports and diagnosed cancer cases to expedite follow-up and treatment and facilitate enrollment in clinical trials. Evaluation includes household surveys of 2000 randomly selected women in the intervention and control communities at baseline and after completion of the intervention; 2000 pre- and post-intervention medical chart audits in intervention and control clinics; and comparison of the time to resolution of abnormal screening tests and clinical trial enrollment between women exposed to the treatment coordination intervention and to standard care. Positive findings from BACCIS can be readily transferred to other San Francisco Bay Area counties through existing coalitions, and can serve as a model for cancer control in other ethnically diverse metropolitan areas.
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|Bloom, J R; Stewart, S L; Koo, J et al. (2001) Cancer screening in public health clinics: the importance of clinic utilization. Med Care 39:1345-51|